Immediate and long-term career goals. The candidate's ultimate long-term career goal is to become an independent health services researcher specializing in complementary and alternative medicine (CAM). The candidate's immediate career goals during the award period include the acquisition of: (1) advanced skills required to manage and manipulate national healthcare datasets, (2) additional education and training in quantitative research, (3) a foundation in marketing research theory, and (4) the skills necessary to study patient decision-making processes. Achievement of the immediate career goals will be facilitated by the following activities: (1) didactic coursework at The Dartmouth Institute for Health Policy and Clinical Practice (TDI) and the Tuck School of Business at Dartmouth College, (2) mentored secondary data analyses, and (3) mentored development of grant-writing and manuscript preparation skills. Research project: The candidate's research project will entail secondary data analyses using the Medical Expenditure Panel Survey (MEPS). The MEPS is conducted annually by The Agency for Health Research and Policy and is one of the largest sources of data on health services utilization and expenditures that includes services provided by CAM practitioners. The research project is a rigorous market share analysis of US practitioner-based CAM services that will examine longitudinal trends in CAM utilization and expenditures. The Specific Aims of the research project are to: (1) Determine how the market share of practitioner-based CAM services by US adults as a proportion of the national expenditures on all health services has changed between 2001-2007, and whether those changes were attributable to changes in patient volumes, unit costs, patient sociodemographics, and/or patient health status;(2) Perform a state-level supply and demand analysis of chiropractic services for California, New York, Texas, Florida, Illinois, Pennsylvania, and Ohio for 2001-2007 to determine whether there are geographic variations in CAM services utilization that are NOT explained by differences in patient sociodemographics, patient health status, or unit costs, but are correlated with the regional supply of chiropractors;and (3) Examine trends from 2007-2011 to determine whether CAM utilization changed at a different rate than did medical services utilization during the 2008-2009 economic downturn. PUBLIC HEALTH RELEVANCE: This research project will be the first to examine changes in the market share of practitioner-based CAM services over time. We will also determine whether there are regional variations in utilization of CAM services and whether such variations are associated with differences in the supply of CAM services, and whether, in recessionary conditions, CAM services act as "normal goods" or act more like medical services (which are fairly recession-proof). These findings will be important to policymakers who need to understand the effect of the introduction of new CAM services into the healthcare market, to consider and anticipate the effect of an expanding CAM workforce on health services utilization within a market, and to anticipate the effect of economic downturns on CAM utilization.